Reevely: Ontario makes a deal with its doctors to argue more later

The Ontario government and its doctors have agreed to punt their biggest argument to a joint committee that can do the arguing later, allowing them to sign a four-year labour deal.

The agreement covers the members of the Ontario Medical Association, whose billings account for nearly a quarter of Ontario’s health budget or a 10th of all the government’s operating spending. The two sides have been stuck in an increasingly rancorous battle since 2014, over … well, over a lot of things, but the biggies have been the government’s desire to cap all the doctors’ collective billings and to cut the fees it pays for some procedures that technology has made much easier and quicker recently, like cataract surgeries.

The government has underestimated doctors’ billings regularly and wanted strict predictability, to know that its forecasts would match its eventual spending. And it wanted to stop paying for some procedures as if they took half a day, the way they used to, when now they take minutes. Generally, these are reasonable things to want.

Negotiations broke down, an attempt at mediation by respected former chief justice Warren Winkler failed, the government imposed fee cuts of over six per cent, the OMA started a pressure campaign, and Health Minister Eric Hoskins released a bunch of data on top-billing doctors meant to shame high-billing docs who supposedly take unfair advantage of the obsolete fees.

To the extent that the new deal — pending a vote by the medical association’s members in the next couple of weeks — puts an end to that, it’s a good thing. The growing hunger of the health system for public dollars is the single scariest thing in Canadian public budgeting these days, and on the whole it’s better to have the doctors who send the bills and the governments that pay them getting along than to have them fighting.

It promises co-operation on getting family doctors for every Ontarian who wants one (on which the Liberal government has already made a lot of progress, at great expense, but on which it has more to do) and in staffing after-hours appointments, saving strain on hospital emergency rooms.

However.

The precise terms of the deal are secret till after that OMA vote. In the meantime, a joint statement says the agreement will not end a constitutional challenge the OMA filed last fall, asking for a judicial ruling that the association has a right to binding arbitration on all pay matters. As it is, the government decides what it’s willing to pay for doctors’ work and doctors decide how much work they’re willing to do at that price. That allows the unilateral cuts the government imposed earlier in this fight. The OMA wants to be treated more like a union of public employees who provide an essential service, though they’re also sort of independent contractors and small business operators and mostly set their own hours.

There’s also the prospect of future fighting. The statement promises “co-management of the Physician Services Budget that would allow both parties to work together to jointly identify savings, update fee codes and account for technological change, among other measures,” with the help of a yet-to-be-named permanent facilitator who has health-care expertise. That person will also be an arbitrator in some instances, the criteria for which aren’t specified.

Finally, the statement says the deal means the government can pay for more doctors to keep up with demand while providing “a predictable physician services budget.” The only practical way to know in advance exactly what the government will spend on doctors’ work is for it to set a hard limit and refuse to pay for services beyond that. Which either means we’ll count on doctors’ working free after a certain point — to which they objected firmly — or doctors are going to be hard to find toward the end of the fiscal year.

A predictable budget is a useful thing, but patients won’t be happy if it comes at the expense of their being able to get the physician care they need when they need it.

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